Diarrhea

Diarrhea is an increase in the frequency of bowel movements, as well as the water content and volume of the waste. It may arise from a variety of factors, including malabsorption disorders, increased secretion of fluid by the intestinal mucosa, and hypermotility of the intestine. It may also due to infection, inflammatory bowel diseases, side effects of drugs, increased osmotic loads, radiation, or increased intestinal motility.

Diarrhea can be an acute or a severe problem. Mild cases can be recovered in a few days. However, severe diarrhea can lead to dehydration or severe nutritional problems. Problems associated with diarrhea include fluid and electrolyte imbalances, impaired nutrition, and altered skin integrity.

Nurses and the members of the healthcare team must take precautions to prevent transmission of infection associated with some causes of diarrhea.

Testing will distinguish potential etiological organisms for the diarrhea.

Inquire about the following:

Tolerance to milk and other dairy products

Diarrhea is a typical indication of lactose intolerance. Patients with lactose intolerance have insufficient lactase, the enzyme that digests lactose. The presence of lactose in the intestines increases osmotic pressure and draws water into the intestinal lumen.

Diarrhea is normal 1 to 3 weeks after bowel resection. Patients who have gastric partitioning surgery for weight loss may experience diarrhea as they begin refeeding. Diarrhea is a manifestation of dumping syndrome in which an increased osmotic bolus entering the small intestine draws fluid into the small intestine.

Loss of control of bowel elimination that occurs with diarrhea can lead to feelings of embarrassment and decreased self-esteem.

Nursing Interventions

The following are the therapeutic nursing interventions for Diarrhea:

Interventions

Rationales

Weigh patient daily and note decreased weight.

An accurate daily weight is an important indicator of fluid balance in the body.

Have patient keep a diary that includes the following: time of day defecation occurs; usual stimulus for defecation; consistency, amount, and frequency of stool; type of, amount of, and time food consumed; fluid intake; history of bowel habits and laxative use; diet; exercise patterns; obstetrical/gynecological, medical, and surgical histories; medications; alterations in perianal sensations; and present bowel regimen.

Evaluate the appropriateness of protocols for bowel preparation on basis of age, weight, condition, disease, and other therapies.

Older, frail patients or those patients already depleted may require less bowel preparation or additional intravenous fluid therapy during preparation.

Provide perianal care after each bowel movement.

Cleanse with a mild cleansing agent (perineal skin cleanser).

Apply protective ointment prn.

If skin is still excoriated and desquamated, apply a wound hydrogel.

Mild cleansing of the perianal skin after each bowel movement will prevent excoriation. Barrier creams can be used to protect the skin.

Avoid the use of rectal Foley catheters.

Rectal Foley catheters can cause rectal necrosis, sphincter damage, or rupture, and the nursing staff may not have the time to properly follow the necessary and very time-consuming steps of their care.

If diarrhea is associated with cancer or cancer treatment, once infectious cause of diarrhea is ruled out, provide medications as ordered to stop diarrhea.

Decreasing the rate of infusion or osmolarity of the feeding prevents hyperosmolar diarrhea.

If diarrhea is chronic and there is an indication of malnutrition, discuss with primary care practitioner for a dietary consult and possible use of a hydrolyzed formula to maintain nutrition while the gastrointestinal system heals.

A hydrolyzed formula has protein that is partially broken down to small peptides or amino acids for people who cannot digest nutrients.

Encourage patient to eat small, frequent meals and to consume foods that normally cause constipation and are easy to digest.

Gil Wayne is a registered nurse and a contributor at Nurseslabs.com. Prefers writing, traveling and discovering stuffs. Not a fan of working in a hospital, but enjoys exploring nursing outside its walls! I like the color gray, but can’t imagine myself in gray scrubs... lol!